Lucy Miller Part 2


Transcript provided by:
Caption First, Inc.
****


 >> OK with got the soft content is now under your belt.  
We're going to start digging in to the actual regulatory 
information about the new ticket, the work incentives, how 
does this all work?  And what are these provisions?  The 
technical aspect.
  So first of all let's talk about what it means to be "using 
a ticket"?  You guys if you are CWICs, you know that Social 
Security speaks in a very precise language.  And the words 
that they use have a very specific meaning.  So it is 
important that we are all talking the same talk, so that we 
can communicate and when Social Security says that a person is 
using their ticket or has a ticket in use, the bullets that to 
you see here on slide 19 define that.  
Using a ticket means that a beneficiary has either assigned a 
ticket to an employment network, or a state VR agency that is 
functioning as an employment network, okay, that's one piece 
of it, or you get even be considered using your ticket for the 
purposes of CDR protection when you are getting services from 
your state VR agency under that cost reimbursement 
[inaudible).  
So for the purposes of the medical CDR protection, that is 
considered using your ticket.  Now, to be considered using 
your ticket, you have to beat making timely progress toward 
self supporting employment.  It's not enough for you to have 
your ticket in assignment or to be receiving services from the 
state VR agency under cost reimbursement, but you actually 
have to be moving forward based on a list of very prescribed 
achievements that you have to be fulfilling as you move 
forward in using your ticket. So that's what it means and 
that's a big difference because now the way that state VR 
agencies can act either as ENs, or work with people under the 
const reimbursement.

When is your ticket considered to be in use?  Well, as of what 
date, when?  The ticket is in use effective the date your 
ticket is either assigned to an EN or to your state VR agency, 
when it is functioning as an EN, or if you've gone the other 
route where you are getting services from the state VR agency 
under the cost reimbursement option, your ticket is considered 
in use when the agency is serving you and you have an 
individualize plan for employment developed and signed.  The 
date on that plan marks the start of in use status.  And it 
would end, when the use status would end, when the state VR 
agency closes your case. 
So, this is an important counseling point.  We need to make 
sure that the beneficiaries we serve are following through and 
participating actively with their VR counselor in getting that 
individualize plan for employment developed, and signed.  
Sometimes we see lags occur, that here is a lengthy period of 
time that it takes for that individualize plan for employment 
to get developed, to get signed, and for an individual who is 
facing a continuing medical disability review in the near 
future, that could create problems.  So there is a counseling 
point.  Making sure that the beneficiaries are aware of when 
the in use green light starts, and to be advocating for 
themselves with the state VR agency to make sure that that 
plan for employment is developed and signed and progress is 
being made to move forward.
Alright, let's look at the new and improved timely progress 
definition. You know, for those of us who are regulation 
geeks, and I have to count myself among that number, when the 
proposed regulations for the new ticket program came out, we 
were reading these things.  Yes, some of us actually do read 
these, and very excited about the changes.  And so for the 
first time in my life I can remember, when the final 
regulations came out, they were better than the proposed 
regulations.  They offer more benefits to the individuals that 
we serve in terms of what activities are counted under that 
timely progress definition.  And unless you really were 
engaged with the old ticket program, I don't think you can 
really appreciate the incredible changes that these represent.  
It’s the full gamut now.  
People can be considered in timely progress all the away from 
preparing to get a GED or pursuing that General Education 
diploma, which is pretty exciting, all the way to the other 
end of the spectrum where they're actually working at 
incrementally increasing the amount of their earnings.  
And the old rules were very much focused on earnings, that was 
considered timely progress, work, work, work.  This shows a 
real recognition on Social security's part that pre-employment 
preparation and education and training is really important, 
and it helps people get better careers, better employment 
outcomes at the end of that, so let's incentivize that.  Let's 
make sure that that is considered timely progress, and that is 
what they did.  I just think that it is incredibly compelling 
to look at what they have allowed.
Now, this presentation offers individuals slides.  In the 
first year here is what is timely progress, and in the second 
year here is what is timely progress, and we are going to 
cover that after we come back from break.  But I am going to 
do it in what I hope is a better way.  Rather than plodding 
through these slides one by one, I want you to have the chart 
that we sent you in front of you.  You can pull that up on 
your computer screen.  Hopefully you have printed out and have 
it in front of you.  It is a wonderful visual representation 
of the various timely progress periods, and we're going to use 
that to teach you what these periods represent and what 
activities have to be completed and I am going to model for 
you the way that you would use this chart when you are 
counseling beneficiaries, because that's what that chart’s 
for.  It is not for you to print off and put in your book 
shelves and three hole punch and stuff away in your WIPA 
manual, that chart is a counseling tool that was developed for 
you to have a million copies of in your desk, so that when you 
work with your beneficiaries you can pull that chart and say, 
let's sit down and figure out where you are going to be in 
here and what those requirements offer you.
That new and improved timely definition, timely progress 
definition, that slide there No. 21, these other broad 
improvements that were made.  First of all, there are 
specified goals of work or earnings, or educational 
attainment. 
First and foremost, attaining a GED in that first year is now 
an approved activity.  That is the one thing that wasn't in 
the proposed regulations that popped out in the final 
regulations.  That was so exciting.  Or, there is recognition 
there that some people need to go maybe through a training 
program or attend an educational program consisting of a 
technical trade or vocation school, and there are a certain 
number of years [inaudible) that you will be making progress 
in that, and the following one is that four year degree or 
even a two year certification degree, that if you're making 
designated amount of progress in that, it is allowable.  
Before we get into the chart on the next slide, just a few 
more basic points in slide 22.  
Social Security eliminated the initial 24 month period that 
the old ticket program had which was kind of hard for people 
to understand.  And I think the new system is more intuitive.  
It is one year, twelve month progress certification period, 
and they are all the same length and time, they’re all twelve 
months long.  And then there is a very logical, sequential 
movement from the progress certification period, where there 
are lower amounts of things to be attained, all the way to the 
end, and the increasing level of employment that are required.  
There are different levels of work or educational training for 
each of those progress certification periods. And, the ones 
that a particular beneficiary is expected to achieve depend on 
that particular beneficiary, what the employment goals are, 
what their plan is with either the state VR agency or that EN, 
in terms of here is what we need to do to prepare you for that 
an eventual occupational goal and we will talk about that 
after a break.  
The whole point of this that Maximus is going to review the 
progress of every beneficiary with a ticket in an assignment 
at the end of these twelve month certification period to see 
did you meet these applicable requirements and to designate, 
yes, Mr. Beneficiary, your ticket is in use and we will 
continue to hold off on those medical CDRs, and moving 
forward.  So that's just the overview.
There is something that is very exciting, which I found 
throughout the regulations and changes.  The regulations 
really have a greater respect and a greater appreciation for 
the fact that life doesn't always happen in a tidy and neat 
little manner.  Sometimes life is messy.  
There is a new variance tolerance in these rules that says, if 
you got really close to achieving the goal, within 10 percent, 
we are going to say you achieve the goal.  We are going to 
give you the benefit of the doubt there.  And I think that 
this tolerance for some variance really is reflective of a 
different attitude and an understanding that Social Security 
has, that life doesn't always happen the way that we planned.  
Even with the best of circumstances, we sometimes fall a 
little bit short and this is a very important change to the 
rules, that if you get within that 10 percent we are going to 
give you the benefit of the doubt and let you move forward 
without threatening those medical CDRs again.
What I need for you to have in front of you if it is possible 
is either printed version of the timely progress for ticket 
users, the quick reference chart.  Or, if you're using the 
computer, pull that up.  It is a word document and have it up 
on your screen.  
This is not one of those sort of esoteric training things that 
when the training is over you throw in the trash.  This is a 
real, usable piece of paper.  We want this to be used when you 
council people.  It is a short, quick and easy way to sit with 
a beneficiary who is either considering ticket assignment or 
has a ticket in assignment.  If you know what that person's 
occupational goal is, and the kinds of things that have been 
planned for in terms of preparation for that occupational 
goal, you can literally sit with this chart and show that 
person what is going to be expected of them in each of these 
tall month periods.
If you look at that chart, here's the way you use it.  At the 
very top left, you see that it goes down by 12-month review 
periods.  In that first 12 months, each beneficiary with a 
ticket in assignment has a choice, depending on what their 
goal is with the En or the state VR agency, of a variety of 
things.  
Let me give you an example.  Let's say that Mr. Beneficiary 
shows up at your door and this is an individual who has never 
graduated from high school.  His goal we go with the EN that 
he's working with, is to get a career working let's say at 
UPS, one of the biggest employers in my area. But in order to 
get a job at UPS, you have to have a high-school diploma.  In 
the individualized plan for employment, the long-term goal, 
full-time employment as a forklift driver with UPS, but the 
steps in the plan to achieve that goal include attending high 
school diploma or GED.  
Well, once that ticket is assignment, that beneficiary for the 
first twelve-month period has to work really hard to get that 
GED taken care of.  That has to be done.  You have one full 12 
month progress period to attain that goal of, and in the 
second 12 months period, you look all the way to the other 
side of the chart, the other piece of the preparation for 
obtaining this job is actually working.  You are going to skip 
over the technical trade or vocational program because that's 
not part of the individual’s preparation.  You are going to 
skip over the degree of certification program for year two 
because that's not part of this individual's preparation, and 
you're going to go right to the work requirement for this 
individual.  
And for that second column of progress period, after the first 
one when he got that GED, that second twelve-month progress 
period, the expectation for the beneficiary is to work six out 
of 12 months with gross earnings at the trial work period 
level or above.  And the level, of course, right now is $670 a 
month and that's before any work incentives are applied, 
gross.
So this individual has one educational step to attain before 
starting to work on employment.  And I am assuming that this 
VEN or state VR agency would be providing job development 
services to help this beneficiary actually get that job in 
that second year.
Let's take another example.  Let's say that Suzy SSDI has got 
a goal of being a schoolteacher.  And she comes to you, and 
has a high school diploma, she has an individualized plan for 
employment with the EN; she's going to be attending a four-
year degree program at a college, to get a teaching 
certificate, to be certified to teach in a public-school.  So 
in the first 12 months, start at the top again, and you look 
across from left to right, high school diploma or GED, that's 
taken care of.  Trade tech or vocation?  Nope, that's not it 
Her obligations in that first year fall under the category of 
degree/certification Program, and here's her marching orders:  
She needs to have completed 60 percent of a full time course 
list for one academic year by the time that First 12-month 
certification period is over.  And that's a very reasonable 
expectation.  
I love the way that Social Security has put percentages of 
course loads or full time for academic year because this shows 
a true understanding that sometimes a person with a disability 
struggles to complete a full academic year for a variety of 
reasons.  Whether you are disabled or not, sometimes that the 
struggle.  But this is a reasonable expectation for an 
individual.  
Well, that's year one.  What about year two?
Well, you just jump down right underneath that, that second 
year, Suzy SSDI should have completed 75 percent of the 
full-time courses for an academic year; third twelve-month 
period,  just keep moving down.  
There should be an additional academic year, the fourth year 
for a four-year program.  Another academic year should be 
completed.  In that fifth 12-month progress period, this 
individual should have completed their four year degree 
program.
Now let's look at that.  This individual has been given five, 
12-month periods, to complete a four year degree program. 
That's reasonable.  What happens after that?  Remember, the 
ticket is about work and this individual would have an 
individualized plan for employment that has a career 
objective.  She wants to be a teacher.  She's completed a four 
year degree program.  When that's over, she's out on the 
pavement trying to get that teaching job, and in the next 12 
months, and subsequent to that, the work requirements kick in. 
At that point she needs to have completed six out of 12 
months, with earnings that preclude cash payment from either 
the SSI or the title II disability program.  That would mean 
that she needs to be working at that level, getting out there 
and working at that level.
These are incremental and people are working forward and 
achieving these occupational goals, year by year, they have 
individual achievement criterion that they have to meet in 
order to be considered making timely progress and making 
timely progress is all about getting that CDR protection.  And 
it just moves forward, year after year, with those different 
requirements incrementally moving up and having a higher 
expectation of people as they move forward year by year.  
So that chart is the best way that I know of to sit with a 
beneficiary and say, year one, here is what you need to do.  
Second year, here is what you need to do.  And then moving 
forward. Some people will reach the maximum achievement very 
quickly.  They won't need lots and lots of years.  
Some people are going to achieve that ultimate work goal, 
which is really working at a level that precludes cash 
payments over a period of six or more years, so everyone is 
different.  The way that this is set up, there is the 
recognition that different people have different occupational 
goals.  Different people will be more preparation to reach 
that occupational goal, and it will take some people longer, 
some people shorter periods of time to reach that goal.  
[inaudible)
Let's go back to the slides a little bit.  We are on slide 24.  
I just want to show you that these slides are here. This power 
point presentation is on our website.  You've got it e-mailed 
to you.  You are more than welcome to print this out, like in 
a handout format, or if you want to print it out as individual 
slides -- these are wonderful notes for you to use, to refer 
back to, until such time as we are able to revise the WIPA 
training manual to reflect the new legislation, the new 
regulations.  
What's in your WIPA manual now is out of date as of July 21st.  
This is all you are going to have for a little while, from us 
anyway, in terms of written information that summarizes these 
progress periods.  
So, you have an explanation of the first one, slide 24, the 
second progress period on slide 25, and all these sites do is 
reiterate, with a little bit more verbiage, what you have 
summarized in that quick reference chart on timely progress.  
There are individual slides the talk about that.
So having shown you that, let's move forward in the slides to 
slide number 29.  And this is the ending of the top progress 
certification period.   Make sure that you understand, what is 
the whole point of ticket?  The whole point of ticket is to 
help individuals work at a level that precludes a cash 
payment.  
Well, for an SSI recipient, that means working at a level over 
that individual’s break-even point.  You see what's out there, 
you have had training on this.  You should know what the 
break-even point is.  So that the individual is now perhaps in 
1619B status, continuing to receive Medicaid, but where 
earnings are high enough that no cash payment is due.  That is 
the ultimate goal.  That is what we shoot for here.  
For a title II disability beneficiary,  meaning someone who 
gets SSDI or CDB, which stands for childhood disability 
benefits, or disabled widow or widower benefits, working at a 
level which would preclude cash payments means that that 
person is earning consistently over, has countable earnings, 
consistently over the current SGA limit or guideline.  And for 
a non-blind individual that is now $940.  For a blind 
individual that amount would be $1,570. So the ultimate goal 
is for each beneficiary with a ticketed in assignment to be 
working at a level which precludes cash benefits, it does not 
mean that people need to give up their health insurance.  It 
means you are working sufficiently that that cash payment has 
stopped.  And you can see that is expected to occur at some 
point within the six years or perhaps even a little further 
down and to be maintained over time.  That's the whole point. 
It isn't just getting to that point.  And it is of course the 
EN's responsibility to provide services that help people 
maintain that level of employment.
Well, what about beneficiaries who already had a ticket in an 
assignment as of that magic date, July 21st?  Well, Social 
Security does have a plan in place.  These are called 
transitional ticket cases, that’s what Social Security refers 
to them as, and you have the instructions here the next two 
slides, how Social Security is going to handle these 
individuals. 
Basically, Social Security is going to take a snapshot view of 
everyone with a ticket already in assignment as of July 21st, 
and applying the new rule they are going to figure out which 
twelve-month progress certification period the beneficiary is 
in as of July 25th.  Now originally, Social Security said we 
are not going to conduct a progress review at the end of the 
first certification, because it seems kind of unfair.  We need 
to let people get used to the new rules, but we will conduct 
progress review at the end of this next progress certification 
period, and I want you to hold that because the news is better 
than that, and you'll see that in a couple of slides down.  
When Social Security does to the progress Review, they are 
going to use the new progress review guidelines under the new 
ticket rules.  So this is a counseling issue for us again.  
For those beneficiaries you are working with who had tickets 
and assignment prior to the new rules, we may need to have a 
discussion with these folks about here is what is going to 
happen to you.  
Certainly as new beneficiaries come through your door saying I 
have a ticket in assignment, this is the time to really talk 
to them about the new rules.  We pull up the chart and figure 
out where that person is in the progress review period, make 
sure that Social Security has done that assessment, make sure 
the beneficiary knows where they are and knows what those 
expectations are of them in order to not be subject to those 
medical CDR rules.

There's going to be some work involved in some of these 
transitional cases, for all of us, for ENs, for Social 
Security and certainly for the WIPA project.
More about transitional cases there on slide 31.  Social 
Security is going to determine which of those 12-month 
certification periods you are in as of July 21st, you meaning 
the beneficiary; and they're going to let that person know the 
number of months remaining in that period so that we are all 
clear where we are.  And, this will be based on the beginning 
month following the month in which the beneficiary first 
assigned to take it under the old rules, and it will end with 
a close of June of this year, right before July when the new 
regulations came into effect.  
This is going to take some time.  This is going to reflect a 
lot of work on social security’s part to take all of these 
transitional cases and figure out where everybody is, and 
we're going to need to work collaboratively with Social 
Security and mop up some of these cases so expect to work on 
that end.
What about people being served by the VR agency, under cost 
reimbursement?  Basically, if that person was being served by 
the state agency before the new regulations took place, 
they're looking at the whole month of July, that person simply 
moves forward, being served by the VR agency under cost 
reimbursement. The ticket is not considered assigned, but it 
is considered in use. That means that person will continue not 
to be worrying about medical CDRs as long as they continue to 
receive those services and are following their plan. 
So, very simply transition really for those folks.  It's more 
the folks that had a ticket in assignment either with the 
state VR agency acting as an EN, or with a private or another 
EN, so those are the ones that are going to require some -- 
[inaudible)

Ok, here is the slide I referred to just a minute ago. This 
was a slide we submitted with our materials for review and 
Social Security that thankfully they added for us, this is 
wonderful news.  Social Security has placed a moratorium on 
these progress reviews through January of 2010.  I think 
that's wonderful.  They're trying to get a feel for how things 
are going.  
For now that is what they're saying the moratorium will last, 
but they will review this issue in January of 09, almost six 
months from now, to decide whether the initial notification 
containing the new guidelines can go out to beneficiaries at 
that time so they can prepare, or what they are going to want 
to do. And I think this is extremely prudent, this is --  
let's hold off, make sure we are all singing from the same 
page, let's not scare everybody about the reviews until these 
new regulations are in place and we are all clear about how 
things are supposed to go.  This is some good news, folks are 
not going to have to worry about those reviews for a while and 
then we will stay tuned in January 09 to find out what Social 
Security decides to do in moving forward and I think that's 
excellent.
We're going to change gears a little bit. What we've covered 
so far are the things that are substantially different under 
the new rules, the stuff that really has changed. And the big 
one is 12-month certification period, a mixture of 
certification periods involving education and work, and a 
recognition that education and educational attainment is 
important for people to have better careers and increase the 
likelihood that they will engage in work that precludes cash 
payments. And where the progress periods reflect that. And 
people are held accountable for a certain amount of 
achievement towards their education and ultimately towards 
work. 
Something this is on the bottom of your quick reference chart 
that I wanted to draw your attention to, there is actually no 
slide about this as I recall, but it is something to note.  At 
the bottom of the quick reference chart there is something 
that says, note, and I'm going to read this because I expect 
that there may be a few of you without your charts. In lieu of 
fully meeting the guidelines for one category of progress, 
social security considers the beneficiary to have met the 
requirements of the 12-month when the percentage of the 
educational or vocational training requirement completed and 
the percentage of the work requirement adds up to 100 percent 
or more.
And you can read that and shake your head and go, what?  This 
is really a reasonable addition to the rules.  Here is the 
deal with this.  Again, Social Security is demonstrating that 
they have a recognition that life is not neat and tidy. We 
don't live our lives in clean, neat, little twelve-month 
progress segments, so it is very clear that for some 
individuals they may not be able to complete the full 
percentage of maybe their four-year degree, but they also 
worked at the same time. We certainly don't want to penalize 
people that maybe are going to school a little less than the 
particular requirement is for their progress period but also 
worked. Some of us need to work while we go to school to pay 
our bills. 
So what Social Security is saying here is, we get that.  And 
let's say you didn't actually, in year two, you did not 
actually complete 75 percent of all whole course load.  Let's 
say you completed 50 percent but you worked some.  And maybe 
you worked at three out of 12 months with gross earnings above 
the trial work period level, which would be half -- 50% of the 
requirement for the work piece for that second year progress 
period. 
So let's add those two together. You achieved half of what you 
needed here, and half here. Together that equals 100%, you're 
good.  We are going to consider you to have made your timely 
objectives. I think that's incredibly reasonable. 
And remember, at the bottom there, in addition, SSA affords 
ticket users that variance tolerance -- provides that margin 
of flexibility because life gets pretty real sometimes, and 
even with the best of intentions and the best effort, Social 
Security benefits might fall just a little short of that 
percentage requirement, and again they I going to give you 
that 10 percent variance and allow you to be considered to 
achieving these goals wing you are maybe 10 percent off, or 
less than 10 percent off.
Again I think this is very reasonable --  these are things we 
can work with, these are things that our beneficiaries need to 
be informed about so they're not necessarily worried when they 
don't exactly meet this requirement but they are within the 
10 percent.  These are very, very beneficial changes and we 
want to make sure that the beneficiaries understand them. So 
there's that piece.
Now we go we are going to move the stuff that either hasn’t 
changed or has changed very little.  For the most part, this 
information is going to still be relevant in terms of what is 
written in your current WIPA manual.  We will be revising the 
training manual for the year 2009, and the entire section on a 
ticket to work, the current section, will be deleted and 
replaced with the new regulations.  Worse case scenario, that 
will be available for you as soon as the 09 version of the 
WIPAmanual is produced.  Perhaps there is a way that we can 
get that publish sooner, but at worst case scenario you are 
going to have that and in the meantime if you do have these 
slides.
Alright, let's look at determining ticket status.  Now, these 
slides are really to give you -- you CWICs, you benefits and 
work incentive planning folks, sort of an inside view into the 
reports, what Social Security calls queries that are available 
within the Social Security Administration to the personnel at 
the field offices.  What they can pull these queries and help 
resolve ticket problems or check on ticket status.  
I am not going to take the 10 minutes that it might take to go 
over each and every one of these different queries.  You have 
a brief explanation of these queries provided here and 
thankfully when the materials went in for review, Social 
Security beefed these up a little bit so we have a little more 
information.
These are queries that you can help request or get when you 
need to figure out what is this person's ticket status.  
Sometimes the beneficiary does not know.  They don't know 
where they are. They know they assigned it but they don't know 
where they might be. They don't know, maybe, if they're 
eligible for a ticket. They don't remember getting one in the 
mail. These are reports that can help us in our research, in 
our sleuthing activity, trying to figure out where are you 
exactly in terms of ticket status.
You will see that there are four reports listed on two slides.  
You have the ticket to work query, the general query, on slide 
36 you have ticket status range query, and the ticket use 
history.  
I wanted you to remember that these queries are described here 
we go and when you have a beneficiary show up at your office 
who is confused about where they are or things don't seem to 
be quite right, this is the person who should have gotten a 
ticket and they say that they did not get one.  Let's see, 
that they get one I signed and they don't remember?  These are 
the pieces of information that you can access to figure that 
out.  
Each field office will be a little different in terms of the 
process they what you all to use in resolving ticket issues.  
You probably need to make contact with your local work 
incentives liaison, or WILL, at each of the field offices that 
you work in to find out what process that field office wants 
you to use.  Are you expected to talk to the WILL directly 
about these ticket questions?  Is it better to go directly to 
the claims representative?  Only your field office personnel 
can provide you direction on that, and this is something you 
need to have conversations about, and you probably need to be 
doing that now so that by the time the new tickets are being 
released to those medical improvement expected in November, or 
by the time those current ticket users who are a little 
confused about where they are start showing up in your office, 
that you are clear on what the procedure is for whichever 
local office you work out of, whichever field offices pull 
from your catchment area, whichever counties you serve. So 
that something you probably need to get started on right away.
Alright, let's take a look at slide 37, ticket and Work 
incentive. There's lots of misunderstandings on this score.  I 
want to make sure that we are all absolutely clear.  Social 
Security treats the earnings of the ticket user in exactly the 
same way as they treat a non-ticket user.
There are no special work incentives that are afforded to 
ticket users, and conversely, there are no restrictions placed 
on ticket users in terms of using all available and 
appropriate work incentives.  
You know how rumors get started.  There have been rumors for 
years about, well only people with tickets in assignment get 
to avail themselves of the extended period of Medicare 
coverage.  Thinking back on that, that’s the provision that 
says that individuals are allowed to keep premium free part A, 
and pay the premium for part B, for a minimum of 93 months 
after the conclusion of the trial work periods.  That 
provision applies to any title II disability beneficiaries who 
works their way off cash benefits.  They're permitted to keep 
that Medicare coverage for the designated period of time, 
whether their ticket is an assignment or not.  That is not a 
special benefit only afforded to ticket users.  If you hear 
that rumor, please do your part in dispelling it.  That is 
absolutely not true.
Using a ticket does provide the beneficiary protection against 
the initiation of medical CDRs.  I think we reiterated that 
about a billion times in the last hour and a half.  It does 
not, however, that last bullet there, protect users from work 
CDRs.  Let's think about that.
The whole purpose of ticket is to promote employment and 
enhance self sufficiency. The EN gets paid the big bucks at 
the end when the individual has become prepared and gotten 
that great career, and is now working at a level that 
precludes cash payments.   
If that is the case, it would be impossible for the ticket to 
protect someone from work continuing disability reviews.  
Those are the disability reviews in the title II program where 
the claims representative is looking to see, are you engaging 
in SGA, are your countable earnings over a period of time 
representing that pattern of work behavior which documents 
your ability to produce substantial gainful employment, or to 
participate in that?
So, please, please, do not let a beneficiary leave your office 
thinking, oh good, if I assign my ticket, I am never going to 
get terminated.  I am never going to have any kind of 
continuing disability review, medical or work or otherwise, 
that is patently false.  We want to make sure people 
understand the purpose of ticket, what it is all about, 
getting the help you need, getting protection from medical 
CDRs during this period of time that you are ramping up to 
engage in this career that will lead to work that precludes 
cash payments, so please do not tell people that they have 
protection from all CDRs, because that would not be true.

On another point, there are rumors going around that people 
who collect their own ticket payments and I am sure those of 
you who have been around awhile, you know some of the 
employment networks that serve people nationally, you assign 
your ticket to them, they collect the ticket payments and send 
a portion of that ticket payment back to the beneficiary.  
It's a wonderful, wonderful way to use the ticket for certain 
beneficiaries but there is a rumor going around that that 
income, those payments that you receive back as a beneficiary, 
from your own ticket, are completely disregarded as income by 
all Social Security disability programs and that is false.  It 
is considered unearned income.  That means that it will be 
disregarded, as is all forms of unearned income by the title 
II disability programs, but you guys know that in the SSI 
program unearned income does count. Unfortunately, the SSI 
program is less friendly to unearned income than it is to 
earned income.  You only get the one $20 deduction, so for 
those individuals who have chosen to assign a ticket to an EN, 
that process the ticket payments and sends some of that 
payment back to the beneficiary, for an SSI recipient please 
make sure they understand that this might be counted as a form 
of unearned income.  So those are some things to watch out 
for.
Well let's take a look at the ticket limits.  One ticket is 
provided per period of entitlement to SSI or Social Security.  
If you establish a new period of entitlement and this does 
happen to people, they do start out with a period of 
entitlement, they worked their way off, they’re terminated. 
Later they might need to come back in.  May be their 
disability becomes exacerbated.  They establish a new period 
of entitlement and they can get a new ticket.
A new ticket account will be issued if your entitlement is 
terminated but you come back under the expedited 
reinstatement, which is almost like a reopening of your 
original period of entitlement.  That's a wonderful benefit 
their, you can get another ticket.  And there is no limit on 
the total number of tickets a person receives in their 
lifetime just like there is no limit to the number of periods 
of entitlement a person receives.  
There is also a common misconception that beneficiaries have 
had, is that, oh my goodness, I'm allowed to have disability 
benefits once in my life and if I lose that I can never come 
back.  No, no, no, no, no. If you continue to meet that 
disability criterion, you can establish entitlement an 
unlimited number of times.  And every time you do that, you 
can get another ticket to use to prepare and achieve an 
occupational goals.
Alright, let's take a look at reassigning ticket.  This is 
basically the same as it always has been.  A ticket is a 
voluntary relationship between an EN and an individual 
beneficiary, and either side can terminate that relationship 
at any time.  
And individual beneficiary may decide, I am not getting what I 
need from this EN, I'd like to go over to ACME Employment 
Services and see what they have to offer. And it's perfectly 
appropriate for that individual to un-assign their ticket from 
one EN and to assign it somewhere else. That can be done at 
any time for any reason. 
There is a process for doing that. You have to un-assign a 
ticket with the first EN, you have to notify Maximus of that, 
you have to assign that ticket to another agency and all of 
this has to be done in writing. This is something that a CWIC 
or a work incentives specialist would be very appropriate in 
helping a beneficiary with.
While you're going through this process, social security 
offers a 90-day, used to read as three months, now it's 90-day 
extension period, in order to get all this paperwork taking 
care of. To un-assign a ticket, to find a new EN, to reassign 
it, and you don't even have to be in current cash-benefit 
status to reassign your ticket.   You can be somebody who may 
be engaged in SGA, in your extended period of eligibility, and 
you are not getting a check right now.  Or you might be an SSI 
beneficiaries working at a level that would be over your 
breaking even point, you would be in 1619B Medicaid status. 
You can still, whether you get a check from Social Security 
are not, take a ticket out of assignment and move it.
Your 12 months certification period will now always resume 
wherever it left off, once the ticket has been moved to that 
new EN.  
Now that extension period that you are given, that 90-day on 
slide 40, is really important because it is a protection.  It 
gives you this little 90 day window to make these changes and 
not have to worry about that medical CDR jumping in on you.  
So your ticket is considered in use during this 90 day period, 
and during that period you have to get that ticket either 
assigned to an EN, or to the state VR agency acting as an EN, 
and the additional piece of this, which is new, is that -- you 
even get this 90 day extension period when you've been served 
by your state VR agency, maybe you've met your goals, they've 
closed your case. They were under the old cost reimbursement 
system.  You now have been a 90-day period if you want 
additional services to go find that EN and continue to be 
protected from the medical CDRs; this is just an amazing 
change.
The VR agency might successfully help you get a job, they 
close your case as a 26 closure  successful to employment, but 
maybe you need ongoing follow-up services, or you need more 
support.  During the 90-day period after VR closes your case, 
you can go find another VN, and your ticket never has been 
used. You were being served under that old cost-reimbursement 
program so you still have your ticket. It's intact. You can 
shop for a provider or if you need additional services, assign 
your ticket to that provider and move forward in those 
12-month progress periods, an amazing change. Very different 
from the way things used to occur.
Alright, the extension period continues on slide 41, just some 
things to remember.  If you kind of drag your feet and you are 
not able, or somehow or other don't get that to get that 
ticket reassigned during that extension period, well as of the 
end of that 90-day period your ticket is no longer in use. And 
that means those medical CDRs may be initiated, and the 
extension period doesn't count when Social Security is looking 
at those timely progress periods, those 12-month periods, so 
they're not going to punish you for that 90-day period when 
you were out shopping for an alternate EN.
One thing to remember, and the bullet here at the bottom of 
the slide reiterates that, you really cannot assign your 
ticket to more than one provider of services at a time.  But 
remember, while you are being served by the state VR agency, 
under the cost reimbursement option, you are afforded the 
medical CDR protection -- when those services end,  you still 
have your ticket, not one bit of it has been used, and you can 
go and assign that to someone else if that is what the 
beneficiary chooses to do or if that is what is needed.
Alright.  As opposed to the extension period, there is also 
something called an inactive status and really this is not 
changed little from the old program.  Basically, there is a 
recognition that life gets real, people get sick, people get 
divorced, people have medical emergencies and family 
emergencies.  They're just not able to perhaps move forward in 
meeting those timely progress requirements, so you can put 
your ticket in an inactive status either temporarily or 
permanently. The bad thing about inactive is -- not 
terminating it, may be putting it on hold,  maybe this will be 
forever but maybe it won't be.  The bad news about inactive 
status is that you are not afforded the protection from the 
medical CDRs during this period, and you can't just drop off 
the face of the earth.  You have to write to somebody.  You 
have to say, I need to go inactive and again this is something 
CWICs need to be helping beneficiaries with. There is a 
process, there is information that has to be provided, you 
have to send it to Maximus, and you may need to make sure and 
follow up that that status was correctly processed.
Months in inactive status don't account in deciding whether 
you're making timely progress but your ticket is not 
considered to be in use during the inactive status.  So, the 
risk of a medical CDR definitely is in play, but it is 
something to know about because sometimes people really do 
need a break, things are going on in their lives, and they're 
simply not capable of achieving these requirements of those 
family progress periods.
Let's talk a little bit about the CDR protections that we've 
reiterated about a million times.  Basically, the rule is that 
Social Security doesn't or cannot initiate a CDR while the 
beneficiary has a ticket in use, OK?  Under the new rules, 
again, this applies to a ticket assigned to a EN, or the state 
VR agency when they are acting as an EN, or when the 
beneficiary is getting served by that state VR agency under 
the cost-reimbursement option. All of that counts. 
If the ticket is assigned after a medical review has been 
initiated, then all bets are off and Social Security has every 
right to complete that review, and can act on that review 
accordingly.  So of course, what's the operative word here?  
What does that word initiated means?  You know, we talked 
about Social Security having a very precise language.  What 
does that mean? 
The CDR initiation date is the date on the notice, the written 
notice that the beneficiary is sent, informing the individual 
that Social Security is about to proceed on the medical 
review.  Now, there is an additional thing that people get, 
called the CDR mailer, of those of you who have been through 
initial training get taught that about the CDR mailer, and 
that system displays the initiation date as the last day of 
the month that the notice is sent.
The CDR initiation date, don't confuse that with the diary 
date; when those of us who do benefits counseling get things 
like a benefits planning query, also known as the BPQY, the 
date that is diaried, that means sort of projected to when the 
next medical review is supposed to occur, that is simply a 
projection that is on the BPQY. You can see when that date is 
diaried, but that isn't the same as the date that a CDR would 
be initiated. 
In some case, it is possible to initiate a medical CDR before 
the diary date. In the overwhelming majority of cases, that 
CDR might be initiated after the diaried date, it's hard for 
Social Security to stay on top of all those dates due to the 
volume of medical CDRs that have to be done.
So don't look at that diaried date, and scare the beneficiary. 
That's the day it's going to happen! Well, the likelihood that 
it will actually be initiated on the diaried day is pretty 
slim, but it is a date to at least keep in mind because it 
shows you when Social Security is expecting that this review 
would be initiated, even if it does actually happen later than 
that. 
Let's see.  What is the end of using a ticket?  You've got 
some points here, it’s very, very basic, the last day of the 
month before the month in which the ticket would terminate and 
we will talk about when the ticket will terminate in a minute.  
Or, it can be the 60th month for which an outcome payment is 
due to an EN, I think a lot of times we don't realize how long 
these outcome payments can go on for.  But 60 months?  My 
goodness, that's five years, and even after some of that 
initial education attain that has occurred.  So ticket 
payments can be spread out over quite a long time.
Or, its the day before the effective date of the decision that 
the beneficiary is no longer meeting the timely progress 
requirements.  Remember, this is a covenant and if you are not 
fulfilling your end of the bargain, using your ticket is going 
to stop.  Your not going to be considered using your ticket if 
you are not meeting those requirements; or, when the 
beneficiary fails to reassign the ticket if you took it out of 
assignment, you get the 90 day extension period, and you were 
procrastinating and not out shopping for that alternate EN, if 
that 90 day period ends, your ticket is no longer considered 
in use.
But don't think that not in use means ticket termination.  
They are at the same thing.  You can see that when the actual 
ticket would terminate, the ticket would terminate the month 
in which entitlement for SSI or when the title II disability 
benefits is terminated for reasons other than work activity.  
Remember, termination is not the same as suspension.  It is 
not uncommon, particularly for SSI beneficiaries to go into a 
12 month suspension when they save too much money in the bank 
or got a little extra unearned income in the month, but those 
people are not terminated.  They are suspended.  You do not 
want to scare people and tell them that their ticket will 
terminate when in fact it won’t.  
So your ticket does not terminate unless your benefits 
actually terminated for reasons other than work.  Or, you'll 
see that in the month when social security makes the final 
determination not to reinstate benefits, and that has to do 
with the expedited reinstatement, where you get that medical 
review and you are found ineligible to move forward under EXR; 
for disabled widows or widowers, it would be the month in 
which the person attains full retirement age, and notice that 
we did not say age 65 anymore because the full retirement age 
isn't the age of 65 for everybody anymore.  It's moving up.  
Gradually.  
This would terminate, the month in which the person attains 
full retirement age, and for an SSI recipient, the month 
following the month the person turns 65 paper; and then you 
have even more stuff on the next slide.  The month after month 
in which the outcome payment period ends, and again the ticket 
stops when the money has all been collected.  
Or, the month the ticket holder again becomes entitled to SSI, 
or title II disability benefits or is awarded expedited 
reinstatement.  So if you terminate and come back into a new 
period of entitlement, the old ticket would terminate an the 
month the ticket holder becomes entitled to Social Security, 
or SSI, non disability based, that would have to do with 
retirement.  
Or, receiving SSI based on being an elderly individual, 
instead of being a non-disabled individual, and that is 
because the ticket is a work incentive for people with 
disabilities.  So it's only applicable to people who get a 
benefit based on disability, and the cheerful thought there, 
the month the ticket holder dies.  Which makes perfect sense.
And the last one there, we are going to end on the positive 
note, kind of wrapping up the whole thing. Terry and have both 
been involved providing training and technical assistance to 
CWICs and before that, benefits specialists under the old BPAO 
program, for a number of years. It's embarrassing to think how 
many.  
And before that, in our previous lives, also working with 
people doing benefits counseling.  And one of the things that 
we've noticed is that in the old days, when after the ticket 
to work and Work incentive Improvement Act was passed, those 
old ticket programs, unfortunately, I think benefits 
specialist were ignoring it.  I think there is a variety of 
reasons why that may have been the case, and I don't want to 
beat anyone up over it.  It is what it is, we did what we did.  
But I think it's time to get over that, to move on, to realize 
that Social Security has made a significant effort to improve 
this program with the whole purpose being to promote 
employment and then had self-sufficiency. And that is what our 
mission is.  That is what we do.  That is our sole purpose for 
being in these jobs.  Ticket is part of that.  Ticket can help 
us.  
It is time for us to embrace this work incentive, and to get 
past some of the former notions that we had that maybe ticket 
wasn’t as useful as it could have been, or maybe, well, hardly 
anybody ever assigns their ticket and none of the ENs won't 
take anybody.  It is a new day, ladies and gentlemen. It is 
truly a new date.  And we have to get past some of that 
baggage that we carried with us from the former program, and 
embrace this and really help it be a success.  Because I think 
we can make a significant difference if we take it seriously, 
if we learned this and use this skillfully at strategically as 
one more tool in our toolbox to help people become employed 
and become more self-sufficient.  
So, that’s my little soap box, ended up.  This is really a 
time for us to move forward and to look at the ticket to work 
with new eyes, to see the positive aspect of this, to be 
marketing quite frankly, truly marketing, this unique work 
incentive to the beneficiaries who come through our door and 
be discussing it with people, not to just ignore it, not to 
pretend that it doesn't exist. We would never do that with 
IRWEs or past plans or student earned income exclusion, and 
this is no different.  It’s a work incentive.  So let's start 
treating it that way and hopefully will see better employment 
outcomes for the people that we serve, and that's what we 
want.

[END]